Provider Demographics
NPI:1093974982
Name:HEALTHDYNE PHARMACY FL, LLC
Entity type:Organization
Organization Name:HEALTHDYNE PHARMACY FL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT&SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:P
Authorized Official - Last Name:BISESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-583-6248
Mailing Address - Street 1:500 EAGLES LANDING DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2899
Mailing Address - Country:US
Mailing Address - Phone:888-479-2000
Mailing Address - Fax:863-686-4710
Practice Address - Street 1:500 EAGLES LANDING DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2899
Practice Address - Country:US
Practice Address - Phone:888-479-2000
Practice Address - Fax:863-686-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
FLPH233893336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2011832OtherPK
MI20200323899433Medicaid
FL001055000Medicaid
VT1017697Medicaid
MN1093974982Medicaid
OK20029370AMedicaid
CO9000170493Medicaid
MD032852900Medicaid
WA1093974982Medicaid
IA0205365Medicaid
KS200636740AMedicaid
WI100080584Medicaid
PA1024462370001Medicaid
ID1093974982Medicaid
IN200972230AMedicaid
FL001055000Medicaid